Allot Healthcare Services York

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

We did not assess this key question at our last assessment. Therefore, the previous rating of requires improvement was carried forward. At this assessment the rating has changed to inadequate.

This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Although care plans were often detailed, they were not always current, consistently implemented or accurately reflected in the electronic information available to staff. We were not able to review initial assessments for people and could not be assured care plans had been developed from comprehensive assessments or were being regularly reviewed and implemented in practice. This was because the provider was unable to provide assessment documentation and records reviewed did not consistently demonstrate people or their representatives had been involved in developing or reviewing their care. People with complex needs had support plans covering areas such as epilepsy, communication needs, pressure care and moving and handling. However, we found information was not always reflected consistently across records and some risks, incidents and changing needs were not incorporated into care planning. For example, care notes for one person referred to them transitioning gender. However, there was no corresponding information within their care plan. Relatives also raised concerns about inconsistencies in care and staff understanding of people's needs when unfamiliar carers attended calls. One relative explained, “Some things (tasks) get lost being done.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider had systems in place to support evidence-based care and treatment, but these were not always used effectively to ensure good outcomes for people. Although care plans were often detailed, they were not always current, consistently implemented or accurately reflected in the electronic information available to staff. Records did not consistently demonstrate effective monitoring of specialist care needs, including epilepsy, pressure care, nutrition and catheter care. In addition, some incidents, wounds and deteriorations in people's health had not been escalated through the provider's governance systems. For example, care records for one person identified concerns regarding constipation and changes in urine colour. However, records did not demonstrate how these concerns had been reviewed, escalated or incorporated into ongoing monitoring arrangements. Although audits were completed, these had not consistently identified the concerns found during the inspection, limiting the provider's ability to demonstrate that care was always delivered in line with current evidence-based guidance and best practice.

The provider did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.

Information about people's care needs was not always shared, recorded or monitored effectively, which meant important information could be missed. Staff and relatives described inconsistencies in communication and continuity of care, and concerns about unfamiliar staff attending calls. Staff told us they relied on handovers, electronic care plans and team meetings. However, records reviewed during the inspection identified discrepancies between care plans, care records, incident logs, audits and information shared with partner agencies. For example, we identified monitoring records relating to seizures, nutrition, pressure care and behaviour that remained in people's homes and had not been routinely brought into the office for review. As a result, the provider could not demonstrate this information was being effectively shared between staff, managers and other professionals to support coordinated care. The provider was unable to demonstrate effective oversight of information held in people's homes, including monitoring charts relating to seizures, nutrition, pressure care and behaviour, and some concerns recorded by staff had not been escalated or reviewed appropriately. These failings meant people could not be assured their care was consistently coordinated between staff, teams and external professionals.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

Care plans identified people's health needs and included guidance for staff on supporting complex conditions such as epilepsy, pressure area care, catheter care, dysphagia and Parkinson's disease. However, these were not always transcribed correctly for the information staff viewed on their devices. Records showed concerns about people's health and wellbeing were not always monitored, escalated or reviewed effectively. We found examples of wounds, skin deterioration, seizures, constipation, nutritional concerns and pressure care issues that had not been consistently recorded within incident monitoring systems or escalated through effective management oversight. For example, records showed 1 person had not been repositioned as required, and areas of skin redness identified by staff had not been recorded or reported. Monitoring charts held in people's homes were often incomplete, lacked evidence of review and had not been routinely brought into the office for audit. These failings meant the provider could not demonstrate people always received coordinated support to maintain and improve their health and wellbeing.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider did not have effective systems to monitor outcomes for people or use information gathered to improve the quality of care and treatment. Although the provider completed audits relating to care records, medicines, incidents and complaints, these had not identified significant concerns found during the inspection, including omissions from incident records, poor oversight of monitoring charts and concerns relating to people's health and wellbeing. Records relating to seizures, nutrition, hydration, bowel movements, pressure care, repositioning and behavioural support were not consistently reviewed by management, and the registered manager acknowledged they had been "remiss" in bringing records from people's homes into the office for monitoring. We found examples where incidents, wounds, seizures, falls and skin deterioration had not been captured within governance systems or used to inform oversight and learning. As a result, the provider could not demonstrate that care outcomes were consistently monitored or that information gathered was used effectively to identify risks, improve care or achieve positive outcomes for people.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider did not always demonstrate robust systems for recording and evidencing consent. Staff generally sought consent to individual care interventions. However, the provider could not consistently demonstrate people had consented to, or been involved in developing and reviewing, their wider care arrangements. Care records reviewed included references to consent, mental capacity, powers of attorney, do not resuscitate forms and people's preferences. Whilst daily care notes also showed staff routinely recorded consent before delivering support, some care plans and agreements had not been signed or dated by the person using the service or their representative. This reduced assurance that consent arrangements were consistently documented.